Health inspection·September 19, 2023

F 0677 nails and he was told they will come back to help him, and they never returned. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #2's Annual MDS assessment dated [DATE] revealed he was a [AGE] year-old male admitted on [DATE]. He had a BIMs of 03 (cognitive impairment) and requires extensive assistance with ADLs. He had diagnoses of Alzheimer's disease (dementia), generalized muscle weakness, and hypertension (high blood pressure). Residents Affected - Some Record review of Resident #2's care plans dated 02/21/23 revealed Resident #2 has an ADL self-care performance deficit r/t dementia, with a goal of resident will improve current level of function in ADLs through the review date. Interventions included bathing showering: check nail length and trim and clean on bath days and as needed, and monitor/document/report PRN any changes, any potential for improvement, reasons for self-care deficit, expected course, declines in functions. No indication of religious preference of keeping hair bald was reflected within the care plan. Interview and observation on 09/19/23 at 01:05pm with Resident #2 revealed he had facial hair that was about ½ of an inch long. He stated that he needed help to keep it shaved and cannot recall the last time he was helped. He stated that because of his religion he prefers to not have any hair. He usually likes to keep all his hair shaved bald which included his beard and mustache. He stated he had asked his daughter to help him shave during her next visit because he was unable to get assistance shaving. He could not recall the last time he asked facility staff for assistance. Record review of Resident #3's Annual MDS assessment dated [DATE] revealed he was an [AGE] year-old male admitted on [DATE]. He had a BIMs of 15 (cognitively intact) and required limited assistance with ADLs. He had diagnoses of unspecified dementia, spinal stenosis (abnormal narrowing of the spinal canal), and hypertension (high blood pressure). Record review of Resident #3's care plans dated 02/02/23 revealed Resident #3 has an ADL self-care performance deficit r/t spinal stenosis and dementia, with a goal of resident will improve current level of function in ADLs through the review date. Interventions included bathing showering: check nail length and trim and clean on bath days and as needed, and monitor/document/report PRN any changes, any potential for improvement, reasons for self-care deficit, expected course, declines in functions. Interview and observation on 09/19/23 at 01:50pm with Resident #3 revealed he had long fingernails that were overgrown his fingertips about ½ an inch and appears to have a dark colored substance underneath them. He stated he liked to keep his nails trimmed and could not recall the last time he had them trimmed. He stated it made it difficult to do small tasks with long nails. He stated he gets his showers on time but did not get his nails trimmed on his shower days. He stated he asked for them to be trimmed sometime last week, and he was told the Activities Director can cut them. When he asked her, she stated she only does the nail care as an activity if he requests them to be painted. He stated he did not want them painted and declined due to the nailcare activity. Interview on 09/19/23 at 2:58pm with RN A revealed the CNAs are the ones who check and trim the residents' nails and facial hair. It should be done on shower days and as needed. The nurses were responsible to ensure it was done and assist if needed. He stated Residents #1, #2, and #3 are not resistant to care and he was not sure why they have not received the proper ADL care and maintenance. He listed the residents who prefer to have long facial hair which did not include Residents #1, #2, and #3. He was not aware of Resident #2's religious preference to keep his hair bald. The potential harm to the residents could be risk for infections from long nails or they might not feel good about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Parks at Garland Healthcare and Rehab 3737 N Garland Avenue Garland, TX 75044 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some themselves by having overgrown facial hair. He cannot recall if any of the residents ADLs had been skipped. Interview on 09/19/23 at 5:10pm with CNA B revealed the CNAs were responsible to help the residents with ADL care such as trimming their nails and shaving them if they prefer to have no facial hair. She stated she could not recall any residents on her hall that had unkept nails or facial hair. She stated they checked them on shower days and as needed if the resident requests a trimming. She stated she was unsure why Residents #1, #2, and #3 did not get their facial hair trimmed or their nails. She was also unaware of Resident #2's preference for being bald. Some negative outcomes of not trimming their nails or facial hair could be getting germs under the nails or in the beard if food gets in it and it looks bad for the family to see them like that and could impact their dignity. Interview on 09/19/23 at 05:55pm with CNA C revealed that the CNAs are responsible to keep up with the residents ADLs which includes trimming their nails and facial hair. If they felt uncomfortable with either of them then the CNAs can ask the nurse for help. He stated he could not recall Resident #1, #2, or #3 asked for assistance with trimming their facial hair or nails. He could not recall if they had preferences on how to keep their facial hair and nails. He stated their facial hair trim and nail trim may have been missed during their shower days. He stated if their hair grows fast then they should shave them as needed and on shower days. If that gets missed it could pose a risk of infection for the residents. The last in-service on ADL care he received was within the last week. Interview on 09/19/23 at 6:11pm with LVN D revealed that the CNAs do the ADL care on shower days and as needed. The ADL care included nail trimming and facial hair. Their ADLs were provided according to their preferences, if they liked a clean-shaved face then that was what the staff would provide. The nurses were responsible to ensure that the ADL care was provided properly. He stated Residents #1 and #2 were not resistant to care but Resident #3 at times refused his shower days. He stated Residents #1, #2, and #3 were not resistant to having their nails trimmed or facial hair trimmed. He was not aware of Resident #2s preference to be bald but stated he had only seen him with hair recently within the last month, and in the past, he had maintained having no hair. The harm that could come from them not trimming their nails or facial hair could be accidentally injuring themselves by scratching and facial hair could be uncomfortable to the resident if they were not used to it or like it long. He stated his last ADL training was last week. Interview on 09/19/23 at 6:32pm with the Activities Director revealed she does an activity called pretty nails. It was for residents who want their nails painted. She does not provide ADL care to the residents with this activity, she stated she would shape the nails if needed and clean them to prepare for the polish. She could not recall Resident #3 asking to participate in the pretty nails activity. Interview on 09/19/23 at 6:38pm with the DON revealed her expectation was to provide ADL care to residents per their needs and wants. She stated the nurses should check to ensure the ADLs were completed by the CNAs, along with herself and other administrative nursing staff. She stated today and the previous day she had noticed a few residents whose ADL care was not completed and requested it be done. She was not sure why the ADL care was not being completed, and stated it was an area that could be improved. She stated that she did notice the need for more education on ADL care specific to facial hair and nail care. The harm to residents could be not feeling good about themselves. Interview on 09/19/23 at 7:13pm with the Administrator revealed his expectation with ADL care was that it was done and done with the care of the resident's comfort in mind, this included nail (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Parks at Garland Healthcare and Rehab 3737 N Garland Avenue Garland, TX 75044 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete trimming and facial hair trimming. ADL care was overseen by the DON and during daily rounds of the administrative nursing staff. He could not recall why the ADLs were missed and stated it would improve with more education for the staff. If the residents did not receive the proper grooming it could cause many issues including residents' rights. Record review of the facility's Activities of Daily Living (ADL), Supporting Policy dated 2001 revealed, residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Event ID: Facility ID: 676039 If continuation sheet Page 4 of 4